RESPIRATORY MUSCLE FATIGUE
RESPIRATORY MUSCLE FATIGUE
复制标题
DOI：
10.1055/s-2007-1006250
复制
发表时间：
1991-10-01
期刊：
影响因子：
--
通讯作者：
CLANTON, T
中科院分区：
文献类型：
--
作者：
GRASSINO, A;CLANTON, T
在发表了表明横膈膜表现为其他骨骼肌的工作之后，1'2 Macklem和Macklosos 3提出呼吸肌的疲劳和衰竭可能发生在许多临床条件下，例如早产儿、长时间机械通气后呼吸肌萎缩、吸气负荷增加（如在急性肺水肿中）、在神经肌肉无力中（如在四肢瘫痪中）或在慢性阻塞性肺病（COPD）患者中。十年后，大量关于呼吸肌疲劳的实验数据被收集起来。然而，在重要的临床方面进展甚微，例如估计其在患者中的患病率，缺乏有效的床边诊断测试，以及缺乏慢性疾病中存在长期疲劳的确凿证据。缺乏更快的进展可能与目前使用的实验方法的局限性有关。事实上，在过去十年中发表的大多数关于呼吸肌疲劳的研究都是在莫诺使用的载荷直至失效方法之后设计的。4假设并发现急性负荷可在临床条件下诱发疲劳，例如脱离机械通气机、5'6运动、7增加吸气负荷、8、9或改变呼吸模式。9然而，在其他临床病症中，例如，那些以呼吸负荷缓慢增加时肌肉力量缓慢进行性下降为特征的病症（如COPD、肥胖、营养不良患者、脊柱后凸、肺纤维化），疲劳发展不太严重。虽然这些情况最终可能发展为慢性呼吸衰竭，但肌肉疲劳不太可能起重要作用。似乎更重要的是呼吸控制系统改变其肌肉激活模式的方式。例如，呼吸的动力，
Following publication of work indicating that the diaphragm behaves as other skeletal muscles, 1'2 Macklem and Roussos3 proposed that fatigue and failure of the respiratory muscles may occur in a number of clinical conditions, such as in premature babies, in atrophy of respiratory muscles after prolonged mechanical ventilation, in increased inspiratory loads (as in acute pulmonary edema), in neuromuscular weakness (as in quadriplegia) or in chronic obstructive pulmonary disease (COPD) patients. A decade later a considerable amount of experimental data on fatigue of the respiratory muscles has been gathered. Little progress, however, is evident in important clinical aspects, such as the estimation of its prevalence in patients, the absence of an effective bedside diagnostic test, and the lack of hard evidence for the existence of long-term fatigue in chronic disease. The lack of faster progress may be related to the limitations of the experimental approaches currently used. In fact, most studies on respiratory muscle fatigue, published over the last decade, were designed after the loading-until-failure approach used by Monod. 4It was hypothesized and found that acute loading can induce fatigue in clinical conditions, such as weaning from a mechanical ventilator, 5'6 exercise, 7 adding inspiratory loads, 8, 9 or modifying the breathing pattern. 9 However, in other clinical conditions, for example, those characterized by a slow progressive decrease in muscle force on a slow increase in respiratory loads (such as COPD, obesity, malnourished patients, kyphoscoliosis, lung fibrosis), fatigue development is less severe. Although these conditions can eventually progress to chronic respiratory failure, it is unlikely that muscle fatigue plays a significant role. What appears to be more important is the way in which the respiratory control system changes its pattern of muscle activation. For example, the drive to breathe, which is